Forms for AHCIP

Apply for AHCIP

• Application form for AHCIP Coverage
• Application form for AHCIP Coverage: Children of Non-Eligible Parents – Use only for your child if you are the child’s parent, you have established residency in Alberta, and you, the parent, are not eligible for AHCIP coverage.

Update information

• Update – AHCIP Notice of Change – UPDATE – Name, address, date of birth, gender, replace a paper card
• Add family – AHCIP Notice of Change – ADDITION
• Remove family – AHCIP Notice of Change – DELETION

Get a replacement card if your paper card is lost or damaged.

Submit form

Download, complete and print the appropriate form. Do not send any information or forms by email.

Submit your application and supporting documents in person to a participating registry.

Group forms

For Government of Alberta and agencies only:

• Group Commencement and Termination form

Supplementary benefits forms

Alberta Blue Cross administers supplementary benefit plans on behalf of the Government of Alberta.

• Proof of Age for Alberta Senior Benefit Program
  • Learn more about the Senior Benefit Program
• Learn more about non-group coverage
• Application for Premium Subsidy for Non-Group Premiums
• Current and Retroactive Premium Subsidy
  • Learn more about premium subsidies for non-group coverage
• Registration for Preauthorized Monthly Payment for Non-Group Premiums
• Alberta Blue Cross Health Services Claim form
• Palliative Coverage Program form
  • Learn more about palliative coverage

If you have questions about benefit forms, contact Alberta Blue Cross.

Find out how to claim for benefits through Alberta Blue Cross.

Statement of Benefits Paid

A Statement of Benefits Paid (SOBP) is a list of physician services paid for by the AHCIP in Alberta on your behalf during a specific period. It includes the date and general type of service, physician name and the amount that was paid to the physician.

The requested SOBP is sent directly to the individual or their authorized representative.

Hospital services do not appear on the SOBP. These may be requested directly from the hospital.

How to order an SOBP

Current year

There is no cost for an SOBP for the most recent benefit year (July 1 to June 30), plus July 1 to the current date.

To request a current SOBP, download and complete the Request for Statement of Benefits Paid form and mail the completed form to the AHCIP office.

Or, place an order using the automated phone system:

• Phone: 780-427-0845
• Toll free: 310-0000 before the phone number (in Alberta)

Previous years

An SOBP can be requested back to October 1, 1993. There is a fee of $25 plus GST ($26.25) per request for individuals ordering a personal SOBP directly.

Families ordering for more than one person on the same AHCIP account pay only $26.25 for everyone.

To request an SOBP from previous years:

1. Download and compete the Request for Statement of Benefits Paid form. (This form is not to be used by law firms or insurance companies.)
2. Mail the completed form with your payment. Only cheques or money orders are accepted, payable to 'Government of Alberta.'

Third-party requests

If a third-party, such as a law firm or insurance company, wishes to request an SOBP on behalf of an Albertan, email us at [email protected] – you need a specific consent form not available on this web page (AHC2099).

The fee for third-party SOBP requests is $75 ($78.75 with GST).

SOBP help

Connect with SOPB if you need help, or are from a law firm or insurance company requiring this statement:
Email: [email protected]